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    <title>Title</title>
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<script type="text/javascript">

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            + "<div style='display: flex; align-items: center; justify-content: center;'>"
            + "<div style='width: 780px;'>"
            + "<div style='text-align: center;'><h2>亳州市城乡居民医疗保险补偿结算单</h2></div>"
            + "<div style='margin-bottom: 46px;'>"
            + "<div style='float: left;'>补偿机构: <span style='border-bottom: 1px solid black;'>" + 123 + "</span></div>"
            + "<div style='float: right;'>补偿金额单位: 元</div>"
            + "</div>"
            + "<div>"
            + "<table border='1' cellspacing='0' width='780' style='text-align: center; table-layout:fixed; word-wrap:break-word;'>"
            // row 1 start
            + "<tr>"
            + "<td>患者姓名</td>"
            + "<td></td>"
            + "<td>性别</td>"
            + "<td></td>"
            + "<td>年龄</td>"
            + "<td></td>"
            + "<td>个人属性</td>"
            + "<td></td>"
            + "<td>联系电话</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 1 end
            // row 2 start
            + "<tr>"
            + "<td>就医机构</td>"
            + "<td colspan='3'>21</td>"
            + "<td>住院号</td>"
            + "<td colspan='2'>22</td>"
            + "<td>身份证</td>"
            + "<td colspan='3'>610631197505241612</td>"
            + "</tr>"
            // row 2 end
            // row 3 start
            + "<tr>"
            + "<td>户主姓名</td>"
            + "<td></td>"
            + "<td colspan='2'>家庭住址</td>"
            + "<td colspan='4'></td>"
            + "<td>医疗证(卡)号</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 3 end
            // row 4 start
            + "<tr>"
            + "<td>转诊类型</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>是否建档贫困人口</td>"
            + "<td colspan='2'></td>"
            + "<td>补偿类型</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 4 end
            // row 5 start
            + "<tr>"
            + "<td>入院日期</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>是否按病种补偿</td>"
            + "<td colspan='2'></td>"
            + "<td>是否保底</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 5 end
            // row 6 start
            + "<tr>"
            + "<td>出院日期</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>单病种定额费用</td>"
            + "<td colspan='2'></td>"
            + "<td>城乡居民补偿额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 6 end
            // row 7 start
            + "<tr>"
            + "<td>起付线</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>医院承担额</td>"
            + "<td colspan='2'></td>"
            + "<td>大病保险补偿额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 7 end
            // row 8 start
            + "<tr>"
            + "<td>总费用</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>个人自付额</td>"
            + "<td colspan='2'></td>"
            + "<td>医疗救助额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 8 end
            // row 9 start
            + "<tr>"
            + "<td>可报费用</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>材料超限自负</td>"
            + "<td colspan='2'></td>"
            + "<td>财政兜底额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 9 end
            // row 10 start
            + "<tr>"
            + "<td>诊断</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>治疗方式</td>"
            + "<td colspan='2'></td>"
            + "<td>其他补偿额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 10 end
            // row 11 start
            + "<tr>"
            + "<td colspan='2'>个人实际补偿额(小写)</td>"
            + "<td colspan='2'></td>"
            + "<td>(大写)</td>"
            + "<td colspan='3'></td>"
            + "<td>180补偿金额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 11 end
            // row 12 start
            + "<tr>"
            + "<td>开户行</td>"
            + "<td colspan='3'></td>"
            + "<td>开户名</td>"
            + "<td colspan='2'></td>"
            + "<td>开户账号</td>"
            + "<td colspan='3'></td>"
            + "</tr>"
            // row 12 end
            + "</table>"
            + "<div style='margin: 10px 5px; font-size: 10px;'>注: 门诊就诊时\"入院日期\"即为就诊日期</div>"
            + "<table cellspacing='0' width='780' style='text-align: center; table-layout:fixed; word-wrap:break-word; border-collapse:separate; border-spacing:10px; '>"
            + "<tr>"
            + "<td>经办人(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>出纳员(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>结算日期</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "</tr>"
            + "<tr>"
            + "<td>审核员(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>负责人(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>领款人(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "</tr>"
            + "</table>"
            + "</div>"
            + "</div>"
            + "<div style='font-size: 10px; margin-left: 4px;'>第<br/>一<br/>联<br/>︵<br/>补<br/>偿<br/>机<br/>构<br/>留<br/>存<br/>︶</div>"
            + "</div>";
        $("#bd").empty().html(htmlStr);
        let htmlStr1 = ""
            + "<div style='display: flex; align-items: center; justify-content: center;'>"
            + "<div style='width: 780px;'>"
            + "<div style='text-align: center;'><h2>亳州市城乡居民医疗保险补偿结算单</h2></div>"
            + "<div style='margin-bottom: 46px;'>"
            + "<div style='float: left;'>补偿机构: <span style='border-bottom: 1px solid black;'>" + 123 + "</span></div>"
            + "<div style='float: right;'>补偿金额单位: 元</div>"
            + "</div>"

            + "<div>"
            + "<table border='1' cellspacing='0' width='780' style='text-align: center; table-layout:fixed; word-wrap:break-word;'>"
            // row 1 start
            + "<tr>"
            + "<td>患者姓名</td>"
            + "<td></td>"
            + "<td>性别</td>"
            + "<td></td>"
            + "<td>年龄</td>"
            + "<td></td>"
            + "<td>个人属性</td>"
            + "<td></td>"
            + "<td>联系电话</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 1 end
            // row 2 start
            + "<tr>"
            + "<td>就医机构</td>"
            + "<td colspan='3'>21</td>"
            + "<td>住院号</td>"
            + "<td colspan='2'>22</td>"
            + "<td>身份证</td>"
            + "<td colspan='3'>610631197505241612</td>"
            + "</tr>"
            // row 2 end
            // row 3 start
            + "<tr>"
            + "<td>户主姓名</td>"
            + "<td></td>"
            + "<td colspan='2'>家庭住址</td>"
            + "<td colspan='4'></td>"
            + "<td>医疗证(卡)号</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 3 end
            // row 4 start
            + "<tr>"
            + "<td>转诊类型</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>贫困人口标志</td>"
            + "<td colspan='2'></td>"
            + "<td>补偿类型</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 4 end
            // row 5 start
            + "<tr>"
            + "<td>入院日期</td>"
            + "<td colspan='2'></td>"
            + "<td colspan='2'>是否按病种补偿</td>"
            + "<td></td>"
            + "<td>是否保底</td>"
            + "<td></td>"
            + "<td>大病不合规费用</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 5 end
            // row 6 start
            + "<tr>"
            + "<td>出院日期</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>单病种定额费用</td>"
            + "<td colspan='2'></td>"
            + "<td>基本医疗保险报销额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 6 end
            // row 7 start
            + "<tr>"
            + "<td>起付线</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>医院承担额</td>"
            + "<td colspan='2'></td>"
            + "<td>大病保险补偿额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 7 end
            // row 8 start
            + "<tr>"
            + "<td>总费用</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>个人自付额</td>"
            + "<td colspan='2'></td>"
            + "<td>医疗救助额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 8 end
            // row 9 start
            + "<tr>"
            + "<td>可报费用</td>"
            + "<td></td>"
            + "<td colspan='2'>材料超限自负</td>"
            + "<td></td>"
            + "<td>财政兜底额</td>"
            + "<td colspan='2'></td>"
            + "<td>180补偿金额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 9 end
            // row 10 start
            + "<tr>"
            + "<td>诊断</td>"
            + "<td colspan='3'></td>"
            + "<td colspan='2'>治疗方式</td>"
            + "<td colspan='2'></td>"
            + "<td>其他补偿额</td>"
            + "<td colspan='2'></td>"
            + "</tr>"
            // row 10 end
            // row 11 start
            + "<tr>"
            + "<td colspan='3'>个人实际补偿额(小写)</td>"
            + "<td colspan='3'></td>"
            + "<td>(大写)</td>"
            + "<td colspan='4'></td>"
            + "</tr>"
            // row 11 end
            // row 12 start
            + "<tr>"
            + "<td>开户行</td>"
            + "<td colspan='3'></td>"
            + "<td>开户名</td>"
            + "<td colspan='2'></td>"
            + "<td>开户账号</td>"
            + "<td colspan='3'></td>"
            + "</tr>"
            // row 12 end
            +" </table>"
            + "<div style='margin: 10px 5px; font-size: 10px;'>注: 门诊就诊时\"入院日期\"即为就诊日期</div>"
            + "<table cellspacing='0' width='780' style='text-align: center; table-layout:fixed; word-wrap:break-word; border-collapse:separate; border-spacing:10px;'>"
            + "<tr>"
            + "<td>经办人(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>出纳员(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>结算日期</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "</tr>"
            + "<tr>"
            + "<td>审核员(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>负责人(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "<td>领款人(签字)</td>"
            + "<td style='border-bottom: 1px solid black;'></td>"
            + "</tr>"
            + "</table>"
            + "</div>"
            + "</div>"
            + "<div style='font-size: 10px; margin-left: 4px;'>第<br/>一<br/>联<br/>︵<br/>补<br/>偿<br/>机<br/>构<br/>留<br/>存<br/>︶</div>"
            + "</div>"
            + "<div>"

            + "</div>";
        $("#bd1").empty().html(htmlStr1);
    })

</script>
</html>